Healthcare Provider Details

I. General information

NPI: 1760657126
Provider Name (Legal Business Name): BRENDA MAE MACGEORGE BURNS D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 EUBANK BLVD NE
ALBUQUERQUE NM
87111-3479
US

IV. Provider business mailing address

9709 DESERT MTN RD NE
ALBUQUERQUE NM
87122-3615
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-8745
  • Fax:
Mailing address:
  • Phone: 505-237-1723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number615RX2
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: